Drug interactions
Hydromorphone + Methylene blue
Severity: Moderate
Hydromorphone and Methylene blue: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Methylene blue is a potent MAO-A inhibitor and has caused serotonin syndrome with serotonergic drugs. Hydromorphone has little serotonergic activity compared with agents like fentanyl or meperidine, so the risk is likely lower, though caution is still warranted for MAOI-opioid interactions.
What this interaction means in plain words
Hydromorphone and Methylene blue can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
MAO-A inhibition by methylene blue may contribute to serotonergic toxicity and opioid effects; hydromorphone has weak serotonergic activity.
What to do
Monitor for agitation, hyperthermia, clonus, and autonomic instability during and after methylene blue infusion; consider a non-serotonergic analgesic strategy if possible.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Hydromorphone
- Alvimopan + Hydromorphone Contraindicated
- Bupropion-naltrexone + Hydromorphone Contraindicated
- Hydromorphone + Isocarboxazid Contraindicated
- Hydromorphone + Olanzapine / samidorphan Contraindicated
- Hydromorphone + Phenelzine Contraindicated
- Hydromorphone + Tranylcypromine Contraindicated
Frequently asked questions
Can I take Hydromorphone with Methylene blue?
MediHelp rates the interaction as moderate. Hydromorphone and Methylene blue can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Methylene blue is a potent MAO-A inhibitor and has caused serotonin syndrome with serotonergic drugs. Hydromorphone has little serotonergic activity compared with agents like fentanyl or meperidine, so the risk is likely lower, though caution is still warranted for MAOI-opioid interactions.
How serious is the interaction between Hydromorphone and Methylene blue?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor for agitation, hyperthermia, clonus, and autonomic instability during and after methylene blue infusion; consider a non-serotonergic analgesic strategy if possible.
What other medicines interact with Hydromorphone?
MediHelp also lists interactions of Hydromorphone with, for example, Alvimopan, Bupropion-naltrexone, Isocarboxazid. The full list is on the Hydromorphone page.
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